To be annoyed I’m having to fight so hard to have an elective caesarean?

[OutPinked]

Basically, after three 10lb babies, my uterus has understandably lost its tone. I am 28 weeks with my fourth and final baby but measuring 32 weeks. I’ve been referred for a growth scan which will be utterly pointless as they always are. They’ll confirm he’s a big baby then do nothing with that information because there’s not really much they can do. Passed GTT with flying colours and I’m not obese, it’s just genetics.

First delivery was shoulder dystocia with emergency forceps and an extended episiotomy. Stitches burst open and became infected, I was in agony for weeks. Second delivery was retained placenta and huge PPH, again I was rushed down to theatre then later given two blood transfusions. It still took me weeks to recover and feel human again. Third delivery went ok but I needed an injection to stem the bleed.

Last year I had medical management for a missed miscarriage. Had a massive haemmorhage, went into shock, fell unconscious and needed emergency surgery+ a blood transfusion. Again, it took me weeks to feel human and I was on iron tablets for months.

DP can’t face the trauma of seeing me nearly die again and I can’t face the trauma of doctors piling in from all angles, jumping on top of me and being rushed down to theatre either. We’ve both decided an elective caesarean is safest. There’s no risk to future pregnancies because there won’t be any. If I do start to haemorrhage again, at least I’m already in theatre surrounded by medics who will immediately be on top of it.
It just seems far more calm and controlled and to me, is an absolute no brainer.

However, I have now seen two consultants who have tried their upmost to deter me. I’ve had almost pointless risk factors thrown in my face (pointless because there’s more chance of dying in a car accident but that won’t stop me driving). I’ve been told that I may bleed more after a CS and when I’ve explained the fact its still safer than risking that blood loss after a ‘natural’ delivery they shoot me down by saying they will still be on hand if it happens after a natural delivery. They don’t seem to grasp that I don’t want them to have to rush in from all angles, I want them to just be there from the off. They also try to deter me by mentioning recovery time forgetting how long it took me to recover after my first and second deliveries as well as the MMC last year.

After yesterday’s consultant appointment, I now have to see an ‘expert midwife’ to ‘discuss birth options’ . Seems ridiculously patronising because my mind is evidently made up but it’s just another hoop to jump through... then I will have to see the consultant again if it’s still what I want (it will be). Argh! To me, it’s just another example of women not being trusted to make the right decision for their own body and I’m tired of it. It’s irritating they reserve so much energy to warn women of risk factors during a caesarean but never ever warn them of what can go wrong during a ‘natural delivery’ too.

Allegorical I had 4th degree tear and all the horrors that comes with this and I was still turned down for ELCS. I was told it will be easier second time around as body has done before. Nope! Baby got stuck, had tear and fractured pelvis and symphysis pubis was stretched out so far that my gait was off and I couldn't barely walk for 3 years. This significantly impacted my life in a lot of ways and cost the nhs money in my after care.

@laney79 I agree with you, someone earlier however said new legislation meant they could not refuse you and I wondered what that was as I know they are refused where I currently work.

Yeah, I agree they do gloss over the risks of vaginal delivery and act like the only complications are with CS, to prove their argument.

A report came out this week with details on which trusts agree straight out (green), those where consultants explore all options and want to know reasons before agreeing and if a consultant isn't happy there is strong enough reason they have to refer to one who will (Amber in the report - this meets Nice guidelines). The final category is Trusts who refuse cs. They can do this - it's up to the consultant whether they operate. It's the latest "birth rights" data.

www.birthrights.org.uk/library/factsheets/Right-to-C-Section.pdf

www.birthrights.org.uk/resources/advice-service/

Sorry LondonerLove - actually OP’s NHS consultants are not all knowing Gods possessed with perfect ability to predict how her birth will go and this what is best for her.
They are humans and sadly this pair have fallen victim to an egregious case of bias which means they are willing to overlook and/or minimise inconvenient statistical data,historical facts and the explicit and legal wishes of their patient because their personal ideology is more important than all that.

I wish they were the only ones - but unfortunately there are still too many HCPs (midwives especially but some doctors too) who possess ideological beliefs that “natural” birth = good, CS = bad and who cares what the National Institute for Clinical Excellence has to say. I have noticed group think on this - you tend to find clusters of anti-CS zealot HCPs in certain hospitals, a bit like you get lots of Amish in Pennsylvania or Trump supporters in Palm Beach.

Ideally it’s best to avoid these hospitals in the first place if you think CS (or even an epidural) might be the best choice for you, but if you realise you ARE under one of these hospitals, your only choice is to get referred elsewhere, where the HCPs aren’t quite so blinkeredly militant.
I remember that back in 2012 UCH London (my nearest hospital) had a sign in bold on the maternity section of its website which said “We don’t agree with elective c-sections so don’t ask us for one”. Foolishly I wrote to them asking how they could justify this appalling, sweeping statement when NICE guidelines say exactly the opposite. The website manager took it down but of course the attitudes have remained - the only difference is that mothers are now unwarned of what they will face.

And finally - as if we needed another reason why OP is DNBU to insist on an ELCS - surveys of female obstetric consultants in the US say that 8/10 would choose a CS for themselves....

Good luck OP, you are doing the right thing.

Unless medically Needed i think NHS should be bearing the cost for elective surgery and if you want it do without medical need you should pay the associated costs.

C-Sections are very very expensive much more then normal births i only know the USA costs but a normal birth in the USA costs about $10,000 thats including the stay and other associated costs a C-section is anywhere between 50,000- 150,000 dollars and should not be a option unless medically required.

*Should NOT

@Bezm the OP isn't slagging off the NHS, in fact given all they've done over several pregnancies, deliveries and an MMC I'm sure OutPinked is extremely grateful for everything they've done to keep her and her children alive. This doesn't mean she doesn't have the right to have autonomy over her body and make decisions, fully informed decisions at that, about how she wants this delivery to happen.
She has done her own research, she is well aware of the issues surrounding having a section and being dismissed by consultants because their view is that vaginal birth carries less risks; several people have already posted that this isn't necessarily the case, and referenced appropriately, and this certainly isn't the case for OutPinked as evidenced by previous deliveries. Doctor's are well trained and consultants are specialists in their field but they are not gods, they have preconceived notions and ideas about how women should give birth, they are not always right, they make mistakes and they should certainly not be effectively telling the OP that she can't have an informed choice.
The OP has already stated that the chances of her ending up in theatre are high, that it'll be a rush, an emergency, where mistakes are a higher probability and it will cause her great anxiety and distress. Why not let her have a planned section, where her past history of haemorrhage can be allowed for and taken into account when performing the section itself, stocking blood products and prescribing the appropriate medications to manage it during and after the procedure. It can be done in a calm, controlled way that causes minimal stress to the OP, the baby, OP's DP and, I'm sure the rest of her children and the wider family.
Why ramp up her anxiety about vaginal birth, which is known to have a detrimental effect on successful vaginal births? Why put her through the totally unnecessary psychological distress?
It's completely unnecessary and, I suspect, down to ego because what she wants doesn't fit in with their rigid clinical view.
As for why she got pregnant again after having such a tough time?
None of your business. That you decided to have sterilisation carried out, after an understandably terrifying and dangerous situation post the birth of your second child, is your choice, one that you made about your body, the OP has made her own choices and is continuing to make her own choices which she is well within her rights to do.

Oops, missed off a bit of sentence there!
It should say " being dismissed by consultants because their view is that vaginal birth carries less risks, is rudely dismissive and inherently sexist (whether the consultant is male or not);"

When they go over the risks of c-sections vs VB do they make sure they are only including PLANNED c-section statistics and facts in that?

@Pickleup - can I ask where you found that statistic, please? I have heard it before (years ago) and have been trying to track it down.

@worridmum - In the UK, the nhs has said that a c-section costs £84 more than a vaginal birth and can be seen as a cost effective alternative particularly when considering the long term costs of prolapse etc related to vaginal births. US medical costs are ridiculous. The NHS cost of birth is between £2~3000, I cant recall the exact figure.

@LondonerLove
Yarnswift has already posted the reference to the cost difference being £84 I believe on page 6 of this thread. Other posters have already referenced a whole host of studies and summaries that show the risk profiles of both forms of birth and make it clear that it is a "trade off" of risk. It doesn't seem like you have RTFT yet you seem adamant that you are right.

I don't mean this as a personal attack, but I really dislike it when people use ignorance as a reason to limit women's choices. The NHS is definitely guilty of providing biased information and encouraging the myths around cost and risk to flourish, it's unacceptable and absolutely not what a healthcare provider should be doing!

Is an ECS any different to a normal CS? My mother had all three of us by CS in the late 50s early 60s and was perfectly fine.

@pickleup

“They are humans and sadly this pair have fallen victim to an egregious case of bias which means they are willing to overlook and/or minimise inconvenient statistical data,historical facts and the explicit and legal wishes of their patient because their personal ideology is more important than all that. ”

These are the doctors she is trusting to slice her stomach open. So you don’t trust their opinion but are happy for them to do the surgery?

Had an elective CS with DD1 and also forced to have GA as consultant "didn't think I'd cope with being awake"! This because of breech presentation (Consultant didn't believe in trying to turn).
Because of this was induced with DS and ended up having what was termed an emergency CS but which was, in fact, simply decided upon at the last minute as the induction the previous day hadn't worked, it was a Friday and the the consultant was due to go on annual leave that night and her senior registrar was going away for the weekend!
DD2 was therefore an elective CS as labour couldn't even be countenanced after 2 CSs.
Recovery from all was pretty quick. Not allowed to drive for 6 weeks but apart from that was ok. A mild infection after DD1 but nothing antibiotics couldn't cope with.

@bumpitybumper slightly hypocritical as you have chosen to ignore the long term effects of a c section.

@pickleup I was pregnant in 2012 at UCH. I don’t remember seeing that statement. But if that is the case I don’t think it’s acceptable.

I’m just confused as to why posters choose to ignore the advice of two consultants. Two consultants who are clearly qualified, otherwise they would not be consultants. We don’t trust their opinion but we will happily place our lives in their hands? They know OP’s history and I’m sure are very prepared for all outcomes. There are many cases where a consultant would advise on an elective c section, unfortunately for OP this is not one of them.

I always find it interesting how much is made of C section recovery time but so little is made of recovery from the injuries of vaginal delivery. I'm not arguing one over the other, just that the extent of the recovery time from vaginal injuries from my birth were never talked about and so were a surprise to me. Especially after being told I would be able to habe sex after 6 weeks!! That was way off.

Your consultants may be resisting because you’re saying a section it safer when in their opinion, and they might be right, is that it isn’t.

Clearly you have undergone several traumatic births plus the miscarriage and you and your partner are understably very anxious about the prospect of another labour. Maybe if you stressed this aspect you’d have more luck?

Or just go to PALS or whatever, NICE guidance is pretty clear, you don’t have to have a reason for wanting a section other than you want one!

"To me, it’s just another example of women not being trusted to make the right decision for their own body and I’m tired of it"

No.

Just because you're a woman doesn't mean you have the knowledge to make the right decision. Having a vagina doesn't give you medical training.

Wow pickleup. Your post makes interesting and shocking reading!
I myself have a friend who’s is an obstetrician and elected for a section for her first child for no medical reason. I only wish I knew her before the birth of my first child.

Peachy peach I am so sorry for what happened to you - I really can’t believe you were made to go for natural delivery again after a fourth degree tear!

Glad you mentioned that, user1486250399.

This Guardian article features a female colorectal surgeon discussing some of the long term damage from VBs - and why she and her colleagues would always choose an ELCS.

www.theguardian.com/society/2008/jul/11/nhs.health1?CMP=share_btn_link

The trouble is londonerlove, that the quality of consultants is not equal. Some are prepared to put ideology to one side and treat each woman as an individual, not a waypoint on a political crusade. Some consultants are not. The latter are bad consultants - regardless of how many textbooks they read at university. And most pregnant women treated under the NHS don’t get to choose which consultant they see. It is effectively a lottery, which isn’t fair on women like the OP who have to go through this.

@Londonerlove
How have I ignored the long term effects of a C-section? Both the cost and risk comparisons of vaginal birth and csections takes into account the short and long term implications. Why are you so adamant that you are right and that csections are inherently more risky or expensive when the evidence just isn't there to support such assertions? It comes across that you are desperate for csections to be more expensive and riskier just so you can deny women that option.

Medical practitioners and hospitals are incentivised to persuade women to choose vaginal birth over csections. There are targets to meet and the way that the costs associated with each method of birth are allocated means that some departments are keen for women to opt for vaginal birth as this impacts their cost centre a lot less than c sections. The longer term costs associated with vaginal births are often absorbed by other departments which is why the myth that c sections are more expensive is so prevalent.

I am nornally a big advocate for listening to professionals when it comes to medical advice however I think you are extremely naïve or disingenuous (or both) to make out that the consultants that OP is dealing with are giving her impartial, unbiased advice.

@pickleup I agree but we are talking about the advice of two consultants, not one. The same consultants OP trusts to deliver her child but not trust their opinion.

@bumpitybumper

Some of the links posted are quite old.

www.google.co.uk/amp/s/amp.theguardian.com/lifeandstyle/2017/jan/21/how-risky-are-caesarean-births

This is a more recent source. Which provides good points to both arguments.
Also it states at the end that c sections are more expensive.
Like I said I am sympathetic to OP cause, even though it may seem that I am not.

I’m sure the consultants have looked at her cases and made an informed decision.